The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER
npr.org
npr.org
This is the kind of things that show how inviable is a market-led economy without proper regulation. Let the powerful profit from the weak and you'll see this kind of thing every time.
If you compare life expectancy in Chile and some other Latin-American countries with universal care[1], they are higher than in the US, despite being a more unequal and/or poorer.
[1] https://ourworldindata.org/grapher/life-expectancy?tab=chart...
Edit: Many commenters miss the point. The US leads the way in too many areas and at least I expect them to be an example of the benefits of free market economy. Some have mentioned that regulation is indeed the problem. I would say, that we need the right regulation so the right incentives are put in place, in benefit of the market and competition. So at best it would be better not to have the industry dictate the regulation.
Additionally, I remember that many supplies come from... the United States? So what regulations are you talking about?
Maybe you meant monopolies?
The Certificate reduces competition because they impose geographical exclusivity. If you want to buy a MRI machine for your clinic, you cannot if the state determines if your area already has enough of them. And if you file a Certificate with the state intending to buy one, your nearby competitors are likely to place objections to your purchase. This is because the machines are expensive and the other clinics want to ensure their investment gets paid for. But this process also ensures they're expensive because the machines aren't able to be built in volumes large enough to result in a cost reduction.
The supply contracts make things easier for the hospital, as they only have to deal with one supplier for an item or class of item. The price is known up front for the duration of the contract. But this also means that the hospital cannot change suppliers if another one has a lower price for the same item midway through the contract period, reducing competition. They also restrict choice by the doctors at the hospital - doctors have strong preferences for items like gloves because of sizing & fit, and the way they transmit feeling through them (thinness, texture, etc). If a hospital changes suppliers to one that doesn't carry their favorite glove, they aren't able to perform as well. And they can't bring their own into the operating room because of liability.
I don't know how many advertisements you see in Chile for medicine, but here in the US I would guess that a quarter of advertisements on TV are for them. All those ads cost a lot of money, and they're not being targeted at doctors, but patients: "Ask your doctor if {brand} is right for you"
I was very surprised the first time I watched an open-tv US Channel seeing thousand of ads for prescription medicine. Which I believe are forbidden the countries I have lived in (CL, ES, DE)
When talking about regulations people usually mean regulating pricing and/or service quality but what actually needs to be tackled are the factors that limit competition, like: - process for opening new clinics/hospitals should have little to none restrictions - requirements for doctors (no doctors from outside can work in the US unless they complete $400k degree) - Drugs from outside countries should be allowed to be imported without FDA's approval
and so on
Regulatory is there to prevent e.g. killing patients in a Therac-25 like events. When you have a too weak reg, you end up with things like 737-max situations.
Now maybe regulatory can also go too far in some niches, but the correct solution is not to blindly go in the other direction.
And anyway, absurd prices in cases of e.g. ER are most of the time explained not by the cost of medical supplies but by random attempts to purely extorts the patients: 6 stiches and a shot do not imply thousands of dollar of BOM, nor are physicians paid hundreds per minute. Look at the cost of covid vaccines if you want to know more realistic costs.
The American culture is one of rugged individualist pioneering cowboys who won't be told what to do, even if you're warning them that if they take another step they'll fall off a cliff.
Honestly when I read the headline my first thought was “six stitches? Crazy glue is cheaper…”
Unless you live across the street from the hospital it's just less hassle to do it that way. Any injury not worthy of an ambulance can be cleaned, glued and taped in the time it would take to sit in the waiting room while they serve all the people who are dying faster.
It’s not like you’re taking up a hospital bed. It’s a sew up and show you the door operation.
You pay nothing for ER, 10eur/day for the hospital and a few eur for medication - but nothing even in the range for 50% or 80%
dental is also covered to a large degree but if you want state of the art you have to pay the difference yourself - but you can also add a private insureance for that for 100 to 300eur/year to have everything covered.
you can still fall through if you can't pay the monthly fee - but emergencies are also free even if you don't pay.
private insurance can be expensive but should usally cover also everything.
I'm public insured in Germany and no, dental is not really covered, I had to pay my routine treatment last time at the praxis, and it was not cheap.
Do you know that if you don't have insurance (which is however mandatory in Germany) you get an actual bill for the medical services?
For the dentist: They often bill you for stuff that is covered but it lucrative to add something to the bill.
You do not need to pay extra for dental if you choose the most basic treatment. Most people like their dental work to look like their natural teeth which does not count as most basic. That is why you had to pay, but only the price difference to the basic treatment.
And, of course, the doc likes to sell you some extra treatment (say "professional tooth cleaning") which will make her/him some extra money.
Same for glasses. The most basic option is free. If you don't like the coke bottle bottoms then you will have to cover the difference yourself.
Imagine how expensive a software dev team would be with 24/7 work, and full cycle scrum sprints every 72 hours to allow for constant pivoting, with injects from one to a bus load of product owners.
A doctor has more training and a lot higher infrastructure costs and overhead, and thus a higher hourly fee.
I spent a couple hours on YouTube and now I can solder my own copper pipes, install a new toilet and anything else I need.
Even being a software engineer I couldn’t compete with the hourly rate of a plumber so it makes financial sense for me to do the work myself.
Plumbers have to deal with the aftermath of butts MUCH more often and they don't have the luxury of someone's insurance they can just throw arbitrarily high charges to.
There’s also the whole ‘all your clients are sick, some are contagious’ thing.
I’m not saying america isn’t insane, but to try and pretend plumbers have it far worse isn’t quite accurate.
Now contrast that with going to a hospital for a procedure where you have time to shop around. Can you get a price? No. Can you easily get appointments with doctors to get their opinions on your case? Maybe. Can you get other patient references? Unlikely (but maybe).
What’s the difference? One insurance covers (thus the patients is cut out of price conversations) and one insurance doesn’t cover (this patient is the end payer). The big problem is more and more costs are being shifted to patients as deductibles and co-insurance, but hospitals treat it like it was 1990 and the patient pays some token amount so “who cares”?
And sure, an emergency doesn’t leave you much time to shop around, but something like 80% of healthcare procedures aren’t emergent.
Also, while $/CPT code can go down, you can see more patients/day or alter your staffing ratios and other operating metrics to more than compensate.
Healthcare has some of the most "woo woo" hand wave-ey financial metrics around. Do a private equity quality asseatment on quality of earnings on "gross earnings" in most health care settings. Other than the Enron consolidations there can't be a more bullshit financial metric (heck entire area) under US GAAP than gross earnings. With that level of obfuscation (purposefull or not) it's no wonder you have almost full opacity into the cost chain.
What did you think the farmer who was charged $6,589.77 for 6 stitches might have to say about that proposition?
In my opinion, getting away from the fee for service model is one of the routes we ought to be taking to address healthcare spending in the US (if you're charging per service, you're incentivized to perform as many services as possible in a given encounter).
Contractors, many of whom are small businesses or individuals, do this all the time. They also give estimates like "If we find mold behind the wall, it will be an extra ten thousand".
Medicine is also odd in that you have to pay for the doctors mistake. If the doctor prescribes a less effective drug, it has no effect and then after doing your own research find a better drug and get the doctor to prescribe that instead. You still have to pay for the first visit. If a plumber decides to go from plastic to copper pipe mid job, he doesn't get paid for the work he ripped out.
Multi billion dollar hospital groups, full of highly educated professionals apparently can't pull this off but the guy who poops in a bucket on the job site can.
> any healthcare procedure that is not typically covered by insurance
Which I (not American) assume stitches in the emergency room are.
Why do you think this discrepancy occurs?
> who was charged $6,589.77 for 6 stitches
is relevant when OP was talking about procedures NOT covered by insurance.
Health "insurance" companies are incentivized to raise the cost of care. Why? Their profits are capped to a percentage of the cost of care. The only way for them to make more money is to have more revenue -- which they do by increasing the cost of care!
The difference is that if a bakery tries to charge you a ridiculous price, you can politely decline tu buy, or buy and promise never to return.
The buyer gets to say they negotiated. The baker doesn't have to look you in the eye when they gouge you.
It gets a little more complicated,though. Instead of just paying $400 for the loaf of bread, the buyer bundles the cost of all the purchases together, and then charges a monthly fee, based on the previous year's overall revenue. They then tack on 20%. So, it turns out, with that extra 20% you're actually paying almost $500 for the loaf of bread anyways.
Is it a scam?
Yes, it's a scam.
The difference is that one is completely optional and you can spend as much time as you want comparing options, while the other you're forced to do on a whim at whatever place is closest. You can't shop around when you're bleeding out, as in the article. And such emergency health care constitutes most of these surprise bill situations.
You don't have better equipment nor doctors in US compared to biggest hospitals in Switzerland for example. Yet we have fraction of the costs as patients, and its not due to low doctors/staff salaries. Equipment is also top notch everywhere, new machines in all departments.
In the US getting wealthy seems to be almost implicitly well respected, no matter how you got there. At least if it's not obviously illegal. You found a tweak to squeeze more money from health insurances? Good for you, let them suffer for their apparent weakness. There's apparently still a threshold of where even success cannot vindicate the way to get there (that Oxycotin family comes to mind) but that threshold is super high. I believe that this threshold is much lower almost everywhere else on earth and that this has an influence on individual decisions on all levels. It doesn't even remotely make people elsewhere angels or something like that, but it's a little bit of friction in every decision towards "take what you can"
A&E can't turn you away. It gave her a few days of waiting in hospital (she was not a high risk patient, but they did want her available and under observation), but it gave her a leading specialist on hand surgery. And we walked out with no bill.
(and you're right - there'd still be the private options too, but in this case the NHS option had some of the best surgeons in the country in that field anyway)
Countries like Finland (4.2k) and New Zealand ($4.1k) show Switzerland could be doing way better.
Maybe the pot shouldn’t call the kettle black?
Changing any one of them isn’t going to fix pricing. We really need to change several pieces at the same time and the industry really doesn’t want lower prices as that reduces their income.
The 24/7 comment was in comparison to dentistry. It’s tempting to compare getting stitches to getting a filling but inherent overheads are associated with an ER which must be added to the bill.
Your opinion sounds nuanced and, therefore, possibly interesting.
BTW, I come from from a European country with universal healthcare and have been living in US for almost a decade and the feeling of someone making money of your health is at least weird. If I ever have some severe health issue no doubt I will go to treat myself to my country of origin.
EDIT: Also tired to hear about the problems of universal health care, specially with wait times. It is true that less important treatments could take some extra time but I have never seen a case where a fast intervention was needed and did not happen. I would say that common sense is something that works for universal healthcare. At least where I come from.
Almost all countries with universal care also have private options (Norway used to be an exception where offering private options for services available from the public healthcare system used to be practically impossible, but even Norway has relented on this though). Often the private options are also cheaper than the US.
E.g. for elective surgeries Americans might want to check London hospitals - many world-leading private hospitals for various conditions that are used to targeting foreign patients - especially wealthy ones - but still often charging much lower prices.
It's also not that unusual for those of us in the UK who can afford to go private to do so when we have some condition that the NHS certainly will treat but where there's a waiting list because it's not important.
And there are plenty of private insurers - only because the NHS offers a baseline, they're far cheaper than most US plans because almost all of them rely on the NHS as a first line and instead of picking up the bill for everything they only pick up the bill to accelerate care whenever there's a wait to see certain NHS specialists.
People need to consider the universal care to be the baseline. How much people are prepared to pay for the baseline over taxes will affect how fancy the baseline is, so if you want something better you'll need to pay. But at least it ensures everyone gets the baseline.
> “The Administration’s recently proposed regulation to begin implementing the law does not uphold Congressional intent and could incentivize insurance companies to set artificially low payment rates, which would narrow provider networks and potentially force small practices to close thus limiting patients access to care,” Rep. Larry Bucshon (R-Ind.), who is a doctor and helped spearhead a letter of complaint this month, said in a statement to KHN.
https://khn.org/news/article/surprise-medical-bills-policy-c...
This shit makes my blood boil. Various vested interests, but mostly doctors, have stymied virtually all legislation (the ACA, Medicare and Medicaid being the notable exceptions) for a century.
https://pnhp.org/a-brief-history-universal-health-care-effor...
"When the arbitration process is wide open, no boundaries, at the end of the day health care costs go up, not down," Becerra says of the methods doctors prefer. "We want costs to go down. And so we want to set up a system that helps provide the guideposts to keep us efficient, transparent and cost-effective."
The system chosen by the Biden administration is expected to push insurance premiums down by 0.5% to 1%, the Congressional Budget Office estimates.
https://www.npr.org/sections/health-shots/2021/11/22/1057985...
People like you think the government should solve a problem that they themselves created.
In theory, but in practice there are many markets where that simply doesn't work, mostly due to natural monopolies, such as any type of infrastructure, healthcare or education, where competition is impractical or impossible, equal access for everyone is extremely important, and costs are high.
Still, nothing really stops competing methods and prices for teaching to competing levels.
By what fraction will the new set of tweaks have to shrink costs to pay for the last 30 years of the private health care market's failure to deliver on its "more efficient" promise? Remember, it has to cut them by 50% just to break even, and it'll have to go further to make this experiment worthwhile. A lot further.
Spoiler alert: it won't even get to 50%. It won't even get close to 50%.
I might be wrong. Maybe price transparency will lead to a 50% reduction in prices in the next few years. I doubt it, though.
A few years back I broke my wrist while bicycling across England. I was patched up and casted a few hours later, I think the bill was about $200, as a foreign tourist. It wasn't even enough to cover my travel insurance deductible. This would have cost me about $5k in the USA.
I agree that the free market works fine, for those who run the market.
All you have to do is ask a doctor "Please don't put any of this in a file until I have insurance next week". It doesn't mean anything to him to add the dates later. It's in his best interest, otherwise he won't get the cheddar.
Healthcare is rarely a good example of the free market. Medical decisions aren’t made by comparing costs between providers. And if you’re in rural America, you’re lucky if you have any provider. Price transparency would be nice, but maybe not as helpful as you’d like. Let’s say you’re in the middle of a rural area and the ER says you need stitches — but they cost $6000. What are you going to do about it? Are you really in a position to negotiate? Your choices might just be 1) get the treatment, or 2) go without.
Many things in rural areas cost more than they should. Usually on this forum we talk about the high cost of internet access and the lack of options, but medical is very similar in that regard. Services are hard to find, providers are covering a very large geographic area, and many costs are higher.
It’s not a good example of how a well functioning free market would work.
It's exactly what any rational person would expect from a corporate free-for-all designed for maximum extraction potential based on maximising political power differentials.
Good state-owned care smooths out the inequalities, so farmers in the middle of rural area will at least have affordable access to basic care, and more advanced care will be within easy travelling distance.
This ends up being far cheaper for everyone who needs medical care - which is basically everyone.
The only losers are profiteering shareholders.
Of course you still pay for it, but you don't pay as much. And you won't be bankrupted by bills for which you either have no cover at all, or limited insurance cover which still leaves you with a huge sum.
It’s hard to even call this a market, let alone a free market. According to the Wikipedia entry on markets, “the usage of the price mechanism to convey information is the defining feature of the market”. It’s notable that in The American healthcare market, the price of your treatment is usually discovered after you’ve agreed to purchase the treatment (or it’s been administered without your consent). In fact, often it’s impossible to figure out what you will pay until after the fact due to how complicated answering that question is.
And even if it were a free market it’s debatable we wouldn’t want to keep it that way. In a commodity free-market of peas for example, a mismatch of supply price and demand price means that some people will pay a suboptimal price for peas while others will be priced out of the market entirely, and they will have to go without peas.
In a healthcare market, when someone is priced out they go without healthcare, which means worse and more expensive outcomes down the line. The old adage about how an irrational market can stay irrational longer than you can stay solvent comes to mind — a healthcare system motivated to maximize profit will price you out of the market longer than you can stay alive.
And then there's the Medicaid reimbursement rates, decided by a committee using the labor theory of value rather than something sensible like cost benefit analysis and negotiation. And since it's illegal to charge someone else less than you charge Medicaid these tend to have a cascade effect.
Our healthcare system is a huge sequence of "make it so complicated that there are no obvious deficiencies" legal systems with layers of ad hoc patches its amazing it works as well as it does.
Normally I'm in favor of free markets but if nationalization is what it takes to clean up the current mess of a system we have then so be it.
Now the NHS is an aberration and under severe pressure, but it is a good indication of just how inefficient Medicare and Medicaid are - and it's not that they can't do better, it's that they're legally prevented from using their market power.
To name a few with healthcare:
Information Asymmetry. It should be expected that a patient does not know what a Level IV emergency is and the complete ins and outs of how they are going to be charged. I'd argue that the industry has intentionally amplified this market failure. Furthermore, patients are often left with the final decision, but who is going to disagree with a trained professional on their required treatment? It's like going to a mechanic when you have no idea what's wrong with your car. You kind of are trusting the mechanic isn't taking advantage of you (and that is regulated). Or you have to reduce the asymmetry by learning about the basics of cars.
Medical research has the attributes of a public good: Non-excludability and non-rivalrous - when something is discovered it's generally known to everyone without dropping in supply and the information is available to everyone (yes the product which results is rivalrous and excludable in the same country, hence it works as a private good - but then that product has non-competitive markets).
Non-competitive markets with respect to rural areas are also mentioned in the article. Much like the issue with utility companies and broadband providers (the latter of which was shown to be a partial public good in the US with the infrastructure bill).
Even I avoid the ER because of costs.
The medical industry is highly regulated. I can't just go open up a practice giving people stiches. I would need a whole slew of certifications in order to do so. That's why this situation in the US is so absurd. The market is regulated to limit the competition at the expense of the consumer.
In the U.S. the "free market" is mostly a myth.
The third party payment system of medicine is both directly paid for by the government and subsidized by tax writeoffs for the private insurance industry (which is tied to employment).
And meanwhile during a pandemic majority of Americans supported Medicare for all. Yet the corporate politicians are against it. The performative art of the "squad" was at full display when they had a chance to force the "Medicare for all" vote and passed on it.
https://www.opindia.com/2020/12/jimmy-dore-vs-cenk-uygur-dem...
https://www.businessinsider.com/aoc-rejects-left-wing-calls-...
https://thehill.com/hilltv/what-americas-thinking/412545-70-...
We deserve what we vote for.
You are sick or even probably sick, like biten by tick and worry about it is infectious. You go to the neatest hospital, local ER, register yourself (no documents needed). Any time of day. You get triaged immediately, if your situation is not life-threatening, there is a queue. Waiting times are anywhere between nothing and two hours. Doctor sees you, you get medication, procedures, tests as needed. Everything is typically done in professional manner, quick and no bullshit. There are sometimes signs hospital is understaffed, like single nurse doing everything.
In Moscow, treatment is world-class. In rest of Russia, your milage may vary.
You typically leave diagnosed, fixed, with documents. Nobody ever asks you about payments or bills. What bills? The state-provided health care is free
Is this true in the public system as well?
I'm asking since in Romania the public hospitals are still more miss than hit, even in big cities.
Hospital managers are politically appointed leading to terrible corruption and inefficiencies, meaning waiting times can be pretty long so the doctors who work there refer you to their private practices, and while conditions on the surface look good and everything is covered by the public insurance in theory, sometimes hospitals are short on supplies, asking you or your relatives to bring stuff from home, the food can be terrible, and you never know what corners some staff might have cut and you end up picking some dangerous hospital transmitted bacteria leaving you worse off than when you came in. And sometimes, if you're unlucky, you can end up in healthcare hell where you get bounced around between different hospitals if each judges you're not their problem to deal with.
Outside of big cities, you don't even want to go near any public hospital unless your situation is serious.
When my mom was admitted to the local hospital for infectious diseases around 2008ish, there were roaches and rats everywhere and this was in a big medical university city of the country. Pretty sure the roaches and rats are gone nowadays, but still that was unacceptable.
Military-serving hospitals are particularly good. There are certain cases of narrow specialists, where commercial medicine is actually worse than that is found in high-prestige public institutions.
I am speaking of Moscow and maybe few other big cities.
Today I learned that doctors and nurses in Russia work for nothing. No? So where does the money to pay them come from?
> Every time someone talks about free this or that in the Nordic countries an American will pop his head up and yell "It's paid for with your taxes" without fail.
And if the parking fee was too much, I've heard that one can go talk to the reception desk and they'll open the gate for you.
I would rather pay very slightly higher taxes and let all of my fellow Canadians have this benefit than be very sightly richer and live in a society that doesn't have this.
I prefer to pay 35-40% in taxes and not have to worry about that. I worry about my work and my systems. They pay me for that. I pay my money so that I dont have to worry.
Paying (a private insurer) to get additional worries? No thanks.
My view on money it that the purpose of money is to solve problems. My goal is not to have more money, it's to have less problems.
I live in a country where I do not ever have to think about how I will pay for my healthcare, which would be an enormous problem to have.
The biggest irony is that’s in line with the taxes we pay in the US (probably more if you’re in tech and live in CA or NY), so it’s not like you pay lower taxes in the Land of the Free anyway.
We received 3 follow-up visits from nurses to clean and redress her wounds --
We pay about 100€ a month for supplemental private insurance on top of the public health insurance here --
Total cost for us? about 40€. We would have had to pay about 100€ more for the nurses' visits, but the mutuelle covered it.
These are some of the reasons why my wife and I moved from the US to France -- she's French, I'm American; but I can't imagine returning to the nightmare complexity of billings and profiteering that the US system has become...
I'm American and live in Norway. I feel the same. My out of pocket here is around $300, after which a lot of things simply become free. I don't have to consider whether or not I can afford to take care of something, and I have trouble explaining how much lower my stress levels are because of it.
My taxes aren't higher than in the US: IN fact, they might be lower than taxes plus insurance premiums - and that doesn't even touch on the deductibles.
I start to think that some people aren't really concerned by the amount they are paying. What they deplore is the idea that some "freeloader" could benefit from their taxes. Even if the net result is that they're spending less.
But the ironic thing is that private insurance also works through "freeloading": you pay your premiums so that somebody else in the insurance pool can get treatment. It's just that some people prefer their intermediary be a private company which will also skim profits off top than their government.
For my family of 4 the most I will pay in any one year is $750.
About 1/3 of people in the US have excellent healthcare and benefits. You don’t often hear from us.
Edit: Also having your health tied to your employer is also a joke. I've read enough stories about people getting screwed by employers who know they need the insurance and get away with abusing employees.
There really are a third of us out there with really great plans. I’m getting downvoted to oblivion but it doesn’t change facts.
I have seen coworkers with cancer or even their family members with cancer and they take six months off with pay and come back like nothing happened.
Be a valued employee at a large company. It’s a completely different situation in the US. It’s actually really good from my experience and as you can tell by my username I’m actually pretty old.
Your "great health insurance" is provided by an employer who is factoring the costs of that in to the price they're charging others for goods/services. Other people are bearing the cost of your privilege. I have little doubt that most folks in your position and companies like yours will generally shop for the lower cost services/products, which will necessarily mean those other companies you're buying from will not be able to provide the "great health insurance" and similar benefits you enjoy.
Handles trash
Landscapes
Makes our shit dissappear
Maintains society
Digs ditches,,makes roads
Prepares food
Etc...
Do those people just not deserve health care?
Reconsider your own life. Picture it with you, yourself doing those things. When I look at mine, the worth of those people is obvious and I am happy to have them doing what they do so I can do what I do and we all meet at the park and let our kids play together.
2) similarly, most drug developments and research are done in the US. EU is effectively leeching off of the US policies. I’d say even Japan by itself contributes more to that end, per capita and in aggregate, than EU as a whole.
3) whenever people marvel at quality of life in countries such as Denmark, Sweden, etc, you have to ask yourself how they got there. None of that is free and other people are indirectly paying for those privileges. In most cases, it’s third world countries that Europeans pillaged for centuries. And in modern times, it’s on the backs of American taxpayers and soldiers who fought to save EU on multiple occasions from their own selfish and inept policies.
- What the hell has to do imperialism with 2021 healthcare systems?
- Healthcare is not a privilege
I have friends who also live in the US, and went through chemo and surgeries there. I did LASIK myself. None of us paid a dollar on top of the annual insurance, for any of it.
In the US I phoned my insurance company, got an Uber down the road to the hospital, and walked in passed the (armed?) guards to sit in a crowded waiting room. Receptionists took my blood pressure twice, was unimpressed with my (international) insurance. 2 hours later I went into some form of casualty area and sat in a chair, had blood pressure taken a couple more times. Eventually someone came and gave me a tablet, then they wheeled in some computer trolley to take my credit card (about $900), and gave me a prescription. There was no informing me of prices up front, no choices (not that you have much of a choice when you're in hospital - for me it was a really minor thing so I actually would have had the choice to either pay or not pay).
A few weeks later at home I received another bill for $2k from the hospital. I believe the bill charged for each of the times they took my blood pressure, I was never asked "would you like your blood pressure taken for $200", I wasn't asked if I wanted to sit in the comfy chair rather than the plastic chair for an extra two slips of latinum, the price wasn't up for negotiation, it just was.
The difference between the two cases is night and day, the UK treatment is fast and free, the US will make you wait for hours and then charge you a fortune.
Just to note, in Wales all prescriptions are free. Can't speak for Scotland / NI.
Like paracetamol say, you'd need a pretty hefty prescription to be able to buy enough all at once that £12 was a good deal. (A standard box is I think 24x500mg, good for three days (4h spacing, but 4x1g max is advised, not 6x) at max standard dosage, can buy two off the shelf for about £1, so you'd need a prescription for almost three months' worth, or a correspondingly higher dose...)
Also, £12 is the one-off price, there are better subscription type rates for people with medium/long-term recurring prescriptions.
But I think it's completely insane we have to play these games with healthcare. Why does it have to feel like gambling and bartering!?
In private practice outside a hospital, they perhaps have more guilt here, but in an ER? They set the prices about as much as the janitors do.
The law here has changed since then to prohibit this kind of thing, though.
The doctors likely have very little say in the pricing.
Most medical practices employee (or outsource) medical "coders" whose job it is to take the notes written by the doctor and determine which procedure codes should be applied (which then determine what gets billed for)
Which hey, I'm glad they are there, but it also isn't "nothing to do with" it.
The human mind loves clear enemies but Hanlon’s Razor almost always applies. Almost no one ever actually has malicious intent, but our brain evolved to watch for enemies and loves seeing patterns where they aren’t.
So what you're saying is there is an horrendous creeping bueaucracy cost here.
Funny, because that's exactly what free market proponents argue is the cause of inefficiency in publicly managed healthcare systems, and the reason to move towards models based on the US system.
Someone is lying.
But wait, the financing in the U.S. is quite predatory, so a lot of people pay nothing, and a few people are stuck with outrageous bills. It's like the infamous SF General Hospital that offered loads of free care to the poor and to immigrants and then refused to take any insurance so that normal people were regularly driven to bankruptcy if the ambulence took them there. The U.S. healthcare is one in which a half a million is spent on emergency care for an indigent person and 10 middle class families lose their life savings of 50K treating snakebites and broken arms.
Once you wrap your head around this, you'll understand we have a very similar problem in higher education, and for very similar reasons.
All I know is simpler systems around the world exist and work such that those 10 middle class families would never get stiffed like that, whilst also looking after the needy.
I can't fathom it.
Agreed. But that's the way it is, and it's important to understand why it's this way.
When Europe and Australia adopted national healthcare systems, the industry was ~3-5% of GDP. So at that point it wasn't politically strong enough to resist either nationalization or strict controls.
Then healthcare mushroomed in size, being ~10% of GDP in Europe and 20% of GDP in the U.S.
So now, when you try to do the politics that the europeans did, it doesn't work. The industry is too powerful. Merely blaming the US for not doing what Europe did misses this essential point.
There are millions of nurses, lab techs, administrators, and doctors, and they have money and they vote. So the left keeps looking for some villain -- greedy insurance executives, Wall Street, Evil Billionaires, etc. And basically refuses to understand that these are not the ones standing in the way of reform. It's the 13% of our labor force that earns 20% of national income, and these are not the same easy targets that the left can attack, because they are a large portion of the US middle class, and are core Democratic constituencies.
That's why healthcare reform in the U.S. always focuses on having the government pay some of the costs charged to consumers rather then reducing the costs of providing healthcare. E.g. more subsidies for this bloated industry, which only results in costs rising even more, and then calls for even more subsidies when people can't afford to pay the costs. When what we should do is fire 50% of the staff and cut the pay of those that remain by another 50%. That's the only way to get affordable healthcare.
And you have a similar problem with higher ed.
It’s you, to yourself. What we have is not by any stretch of the imagination a free market solution. It’s insane amounts of paper pushers created by the government. The whole insurance system we have is an impractical mess designed to fail. The free market would never have designed something so customer unfriendly, people would have gone elsewhere had competing solutions been allowed to exist. In a free market, you are free to go somewhere else.
Our health system is designed by the government, by way of outlawing everything else. If you want to talk free market, in the early 1900s it was common for large companies to keep a doctor on staff and offer their services to employees. That was essentially outlawed.
The rise of cash only flat rate doctors in current years is the closest thing we have to free market, and they’re great. Prices posted up front. No back and forth with insurance companies.
I'd be interested in how the free market develops that solution. At the very least, regulation would be involved. And we all know how adept the free market is at getting around regulation.
Anyway. I'm off to go lie to myself some more. Cheers.
> The whole insurance system we have is an impractical mess designed to fail.
You shifted the boogeyman from corporate suits to politicians in the space of a few comments. If nobody has malicious intent then nothing was "designed to fail". It just doesn't work as expected or wanted by anyone involved.
Sorry if some of us, in our biased minds, suspect that some of that money is spent in cigars and expensive suits.
(1) - https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD?most_...
Insurance companies are definitely lying (their execs are paid tens of millions) though it should be noted that the US system greatly limits the ability to spread insurance payments on health populations, so it makes sense that the population using medical services is a larger share of the insured population, and thus has to pay more.
Anyway more generally the administrative overhead of US healthcare is absolutely enormous e.g. as of 2017[0] it was almost 35% of medical expenses, versus 17% in Canada (up from respectively 31 and 16.7 in 2003).
> [Administrative costs per capita in the US versus Canada are] $844 versus $146 on insurers' overhead; $933 versus $196 for hospital administration; $255 versus $123 for nursing home, home care, and hospice administration; and $465 versus $87 for physicians' insurance-related costs.
So the admin overhead in the US (v Canada) is:
- 5.78x on insurance
- 4.76x on hospitals
- 2.07x on nursing homes, home care, and hospices
- 5.34x on physicians
Importantly though you did not list drug companies in there.
Drug costs are completely out of control in the US (some generic and out of patent drugs have seen price increases of 80x in a decade), and AFAIK modern treatment regimens tend to include a lot more different drugs.
At the hospital level, aside from the administrative overhead above, as an other commenter notes there is also the issue that because it's not a single-payer public health system hospitals have to compensate for indigent ER clients by billing more to, well, people who can pay.
Then of course there's the issue that because all the incentives are fucked under the US system it's being used the least efficient way possible e.g. medical costs are sky-high, so people can't have a GP, so they can't take care of their conditions until those go south, at which point they go to the ER which is the most expensive and least efficient medical service center.
And then the ER's job is to stabilise them, but they still don't have any more money to pay for long-term treatment than they did before having to go to the ER (less, really), so they can't follow through, so they degrade again, and back to the ER.
That said, I don't think this excludes the possibility that the insurance companies and the hospitals are also not telling the full truth.
And you can't shop around for cheaper treatment. Partly because you are not in position to do so and partly because no one will tell you full price in advance.
America somehow spends far more than any other country on healthcare and yet patients still have some of the highest out of pocket costs even when they have expensive private insurance schemes, something is clearly broken to anyone looking and it's not the homeless causing it.
As for why the US spends more than any other country: it's due to an overabundance of caution among the comfortably insured. It's much easier to get a variety of expensive (and often unnecessary) tests and scans (such as MRI scans) in the US. In countries with universal health care these tests and scans are restricted only to those with demonstrable need and they may be subject to long waiting lists.
If it's an HMO, often it's just free entirely. PPO plans tend to have a small fee -- it's never been enough that I've given it a second thought -- and have wide coverage with few limits.
Countries with universal healthcare also tend to have private health companies which can provide tests and scans at a higher speed, either on an insured or a pay-as-you use basis, typically at much lower costs than the US. Yet there doesn't seem to be the same "overabundance of caution" elsewhere. To the extent that precautionary procedures are responsible for high US spend, I don't think that can be decoupled from a system designed to ensure that primary healthcare providers are sales outlets for those procedures.
I mean, it's clear that it's not sustainable to have a healthcare system in which stitches cost this much. Things are not made any better or less outrageous if these costs are transferred to someone else or if they are paid out of pocket.
Except if the US is literally falling apart and had ab endless amount of non paying people?
https://www.aha.org/fact-sheets/2020-01-06-fact-sheet-uncomp...
But if you look at healthcare spending as a % of GDP: the US has the largest public healthcare system in the world, and it has a private healthcare system that invests very heavily in people's health (I think people get confused about this because US life expectancy isn't much higher but that is largely a function of things like obesity that, ultimately, aren't solvable without people eating less...the US does very well with quality of life and difficult to treat stuff like cancer, I am in the UK and a lot of cancers are treated properly, there is just no money to do so).
So, imo, the US is more expensive than similar systems like Germany. But incomes in the US are much higher, people are willing to spend more (particularly on quality of life stuff like joint replacements), and a lot of the additional cost is not in treatment but admin. Maybe moving to a public insurance system would help but look at France: public healthcare system, and doesn't spend that much less than the US (and in the US, public healthcare prices are cheaper than private but private does subsidise the public...and the gap isn't huge)...doctors don't work for free, medicine isn't free, nurses aren't free, you just pay the same but in taxes (btw, I think a public healthcare system would reduce costs by removing admin...would they like it when they couldn't get a knee replacement? No. Would they like it when a parent got cancer or their kid has a rare type of epilepsy and they can't get medicine? No...there are trade-offs, fully public healthcare systems generally do not perform as well as mixed systems like Germany or Netherlands...making insurers non-profit might be a good first step).
Your reply is well-stated. There isn't one single 'bad guy' in the US system; it's more a function of a bunch of little factors that nobody wants to change: the US has the best, highly trained doctors (expensive), best equipment/hospitals (expensive), subsidizes much of the drug development for the rest of the world (for better or worse), and a weird public/private system where the private insurers make up for lower payments from public insurance like Medicaid/Medicare.
In talking with a number of physicians, my biggest concern is that they're starting to feel like most of the 'reforms' and changes the US is making are impacting them the most. None of my physician friends recommend their children go into the profession, and many are leaving poorly-run hospital systems to focus on boutique, private practice (catering to the rich.) We have a huge healthcare provider shortage coming, and I'm terrified the system is straining hard as I get older and will need to start relying on it.
https://www.ncsl.org/research/health/health-insurance-premiu...
We are already in the midst of a provider shortage.
Hospitals are for profit corporations. Doctors are reviewed on how much revenue they generate per patient - usually by asking for more diagnosis and treatments - which is what patients want too.
Too much admin, too little doctors. Someone should get the admin to doctor ratios at hospitals, it is nuts. A lot of admin is there to handle the insane documentation requirements, software, machinery and dealing with insurance providers.
Insurance providers have their own army of admins, talking everyday to hospital admins.
On top of this, supplies providers know that insurance is going to foot any bill. So they charge more. Insurance tries to negotiate it down but there's only so much they can do - unless they buy stuff directly from China or somewhere else.
To add, each of these institutions has their own management ladder with fatter paychecks than the doctors themselves. These folks are nothing but leeches who just need the corporate ladder to exist.
Unfortunately, the only capitalist solution out of this is to allow massive production of doctors (blocked by AMA), allow doctors to unite and form their own hospitals willy nilly (harder than you think because legal requirements are burdensome) and for insurance providers to compete in open market - as they do for cars. No more open enrollment.
FWIW lots of hospitals are non-profit (though I expect that changes are investors are moving more and more into the space).
That doesn't mean they don't focus on doctor's revenue, it only means there are no owners skimming off the top, but there are still execs being paid (a lot), as well as suppliers, etc... I'm not saying NFP hostpitals are worse (or even as bad as) FP, but they're hardly good.
1) Insurance companies don’t pay sticker prices. They pay negotiated rates. At the same time, hospitals have to pick up a lot of ER costs that are never covered. They might be making money but reasonable amounts at best (also that’s probably not true either considering how many hospitals are shutting down in the US).
2) The negotiated rates insurance companies pay are still very high. They are probably making a good profit, but their margin is still probably a fraction of the margin of many other industries, and it’s not like they have no competition, so they do have market pressure to reduce prices.
3) Doctors pay a ton in education and liability insurance and delayed earnings due to the extensive education required. They can spend over a decade, and be into their 40s before their net worth turns positive.
So where is all the money going is an excellent question. No one is benefitting from this current system.
1 obvious destination for the money is the education system in the US. Higher Ed in the US is an increasingly growing money pit. Tuitions are exploding. Loans are exploding (and educational loans are unique in the US in that they cannot be canceled in a bankruptcy). Administrative salaries are blowing up. Ever fancier buildings are being built. Yet money for teachers, researchers and remasters/phds is plummeting. It’s a complete scam with the entire system paying ever more money to build fancy buildings, the vast majority of the cost of which is captured by corrupt contractors with connections to university presidents, etc.
Then you have the pharma industry, which unlike any other civilized society, needs to advertise to consumers in the US. This means they have pressure to constantly grow their sales and once popular enough they have parents, and once generic, brand value, to force hospitals and patients to buy overpriced drugs.
But the US can’t outlaw pharma ads like nearly every other civilized country has, because that will then destroy your Media and Tech industries, and where ads, and therefore pharma ads, make up a massive source of income.
And I’m sure the same dynamic probably applies to medical tech as we’ll.
So in honesty, the money is likely going to the places that are showing that they are receiving money. Not in the healthcare system, but rather to tech, media, and construction and real estate.
Instead of any kind of dramatic increase in patient results, this system instead protected truly terrible doctors like the murderer Dr. Christopher Duntsch.
Meanwhile, in developing countries, it's not that hard to find a decently qualified doctor running his own small clinic with couple of nurses in a busy street. And to the next level, there is always a small 20-bed hospital around with 3-4 doctors and a bunch of nurses. And options keeps increasing in size and cost from small to the big hospitals like you typically see in the US. Almost 95% of primary healthcare are met by these small-mid level operations and people go to the big hospitals only for complicated surgeries and intensive care.
In this example of just 6 stitches, it probably would have been administered by a nurse in a 20-bed hospital for fraction of the cost of a big hospital.
It’s the same in Germany, so I’m not sure that actually is what makes things different.
the US is not a poor country, it is an astonishingly rich country whose elites want poor (and working-class more generally) people insecure so as to maximize the degree to which they can be exploited via economic coercion.
Insurance paid UCSF $16,000 after discount.
So I’d say the hospitals definitely are a part of the problem.
You can imagine what he did with a fund raising letter he got from UCSF asking for a donation so they could continue to help the community…
Even the private clinic is making bank like there’s no tomorrow.
Their standard lower back MRI was $400.
Price competition can be fierce in MRIs since the startup costs aren’t high and you can pull patients from everywhere.
There you go. The insurance company is actually incentivized to not negotiate a lower price.
What if they refuse a ludicrous price? Their customers will complain -- what, what? go without MRIs?
Worse -- the insurance company gets to keep 20% of the costs as profit. For a $16,000 bill, that's $3,200. For a $3,000 bill, that's just $600.
So why, again, would they fight for a lower bill? No reason. Competition from other companies? Unfortunately, they're all playing the same game, and lower premiums are simply not happening.
The insurer did negotiate the price down - from $20,000, so a 20% discount.
But yes, UCSF just leverages their name and the desire for insurers to have them in network. Their attitude is basically “no, I won’t go lower, and you’ll pay anyways”.
No, insurance companies don’t keep 20% as profit. They can keep 20% in reserve, the rest has to be paid out as benefits that calendar year. United Healthcare’s profit margin is like 2-4%.
And of course they fight to lower their insurance premiums, that’s how they attract new customers.
I've just got to point out that they're adding back 20% -- to keep in "reserve," as you say. So what's the advantage of insurance? The "premiums" force the scam pricing on everyone! (And not just the direct victims of this type of fraud.)
I'm willing to believe addicted's[0] rationale, but maybe most people are getting paid poorly, there's just more of them in the system?
> US health insurers report billions in first quarter as small providers face stress
> UnitedHealth Group, reported $4.9bn in profits in the first quarter of 2021 while CVS Health reported $2.2bn
- https://www.theguardian.com/business/2021/may/08/us-health-i...
> Major U.S. Health Insurers Report Big Profits, Benefiting From the Pandemic
- https://www.nytimes.com/2020/08/05/health/covid-insurance-pr...
> The health insurance industry continued its tremendous growth trend as it experienced a significant increase in net earnings to $31 billion and an increase in the profit margin to 3.8% in 2020 compared to net earnings of $22 billion and a profit margin of 3% in 2019.
- https://content.naic.org/sites/default/files/inline-files/20...
I'm in the US.
* I paid $20 K out of pocket for a surgery that my insurance would not cover.
* A few weeks after surgery, I developed a complication that left me in HORRIFIC pain several hours / day.
* Almost immediately after development of complication, I got ANOTHER $20 K bill from the hospital.
* I read the fine print on my contract, "HOLY SHIT. THEY CAN DO THIS????"
* Meanwhile, horrific pain persists, day after day.
* Wife says, "You need to go to ER."
* Me: "NO WAY. You wanna get hit with ANOTHER $20K bill because I developed a complication due to a procedure that the insurance refused to cover from the get-go? I'll ride this out."
* Horrific pain persists. I cancel a lot of my work.
* A few weeks later, I have a follow-up visit with surgical group.
* I tell surgical group, "I got this $20 K bill ON TOP of the $20K I already paid."
* Surgical group: "Oh. That's a billing error."
* I explain very s-l-o-w-l-y that I did not deal with my horrific pain for WEEKS as a direct result of receiving an erroneous bill and that there may be a lawsuit coming someone's way.
* 15 minutes after leaving my follow-up visit, I got 3 phone calls from hospital admins and surgeon expressing profound regret for the error and assurances that the bill was "gone."
If I could leave the US, I would for this simple reason.
Even as a well paid software engineer, I’m strongly eying other countries where your life and death isn’t seen as a massive profit center for investors.
The Australian government covers hardly any dental unless your teeth have completely rotted through and are chasing other issues.
So far my costs are:
- $4500 in fillings and general dental.
- $1800 for a crown (gold).
- $350 consultation with surgeon (via zoom).
- $1100 for 30-40 minutes (max) of a theatre room for the initial operation.
- $4000 for the surgeon for 30-40 minutes.
- $450 for the anaesthetist.
- $0 for X-rays (covered under Medicare).
- $150 transport.
- $YTD medication post surgery.
- $YTD follow up dental work.
- $YTD additional surgery to cavities from the top teeth into the sinuses - this is only a maybe, it's a risk.
Total so far in the last 3 months has been over $12,000
What stand out for me is how can the surgeon charge $4000 for 30-40mins of active work, and I'm assuming a little paperwork.
Having said all that, I admitted myself to the ER earlier this year and spent the day there having a bunch of tests, didn't cost anything at all and no insurance required.
While healthcare in Australia is generally pretty decent,dental is significantly lagging behind and expensive.
Sure you wait a while for our public health stuff if it’s not life threatening, and if you’ve got the cash available then private is faster/fancier, but the public system does work.
This was after I had referrals from my dentist and a second opinion.
I do have some complications with a major nerve running about 1mm from one of the largest tooth's roots and I was told when there's some risk of damage to facial nerves you should make sure you get a good surgeon.
My missus needed highly specialised but relatively quick and low-risk surgery. Maybe 3 surgeons in the whole country do this particular procedure. Think 30 minutes in the OR, a couple of hours to wake up from the anaesthesia, and then you go home.
$4,000.
And then the anaesthetist sent a separate bill.
What does Medicare + Private Hospital cover out of this? A grand total of $130.
It turns out that this particular procedure has no specific "code", so it's lumped in with a routine day surgery billing code. Which is something like $270, with $130 covered by Medicare.
Now, if you ask me, $270 is too low, $4K is a tad high, and 100% of both should be covered by Medicare.
I looked into it, and it turned out that the Medicare refunds are based on "fixed prices" determined by the government decades ago, and haven't changed since then. Private insurance "goes by the government pricing" because it lets them get away with paying you pennies on the dollar.
Realistically, you're not getting any kind of surgery with general anaesthesia for under $1K. Don't worry though, the government and your insurance company will give you maybe a bit over 10% of that back! They have you "covered".
There must be other countries with cheap care.
Someone should make a startup for that.
Is there any other profession with this kind of pay?
Actually I paid for it in advance with my taxes during my past jobs, and that's the whole point of universal healthcare: it's an investment for those who one day will need it, and a form of contribution for everyone else. Frankly I have never understood those who oppose it; are they so anally retentive wrt their money that they can't renounce to a fraction of their income to help others, and potentially themselves too?
Here in the UK we have the NHS which is great. But we ALSO have private insurance / hospitals / healthcare that is reasonably priced.
Also, in a country with both, the private system can't be any worse than the public system because it has to compete with it, so the fact that the UK has good private healthcare doesn't necessarily mean that it will be easy to fix the private system in the US without the existence of a nationalized system as well.
Costs for treatments are standardized and agreed on nationally: you can go and look them up. Your bill has codes on it that match this list. It is called TARMED: https://www.bag.admin.ch/bag/fr/home/versicherungen/krankenv...
Insurers under the LAMal system are restricted in what they charge for premiums too, and must negotiate this with the confederation.
There's still a lot of scope for private companies to make money here. LAMal covers what are deemed essential treatments, which is most things you need a doctor for. If you want 'alternative' medicine there are insurers you can pay more money to for that. Likewise, if when you go to hospital you want a guaranteed private room every time, then you can pay extra for that. And so on.
Even on the basic system, you have a choice between telephone doctor for all appointments except emergencies, family doctor for the same or the unrestricted system where you can ring up a specialist yourself without referral. Needless to say, the one where you ring the insurer first is cheaper, followed by the family doctor (similar to the UK: referrals are controlled via your GP).
I don't see any poor doctors here, or poor insurers either (insurance, behind banking, is a massive business here). So it is entirely possible to design a system that includes a large amount of private insurance that also doesn't randomly try to bankrupt people for getting stitches.
Here in my municipality in Norway the media keeps repeating how/where/when to get tested, and if anything important changes the municipality will literally send a SMS to all its citizens to ensure as many as possible are up to date.
From my admittedly limited experience with the US (NYC/tri-state area) I get the impression that information is often hard to find and hard to understand. This could of course be caused by cultural or lingual differences since I'm neither American nor a native English speaker.
The emergency room is the last place you’d go for a simple test. The only reason you should go to the emergency for a test is if it’s heart related or you think you may die (an emergency.)
It is called "health care" and you are doing neither.
I live in a second world country called Poland and even here with all our failings and problems we are not afraid to go to ER when we need stitches.
Organizing medical help should be basic responsibility of a government the same way it should be to get its children to be educated and have good start for life.
Nation is a collection of people that work together so that they can prosper but, most importantly, fulfill their basic needs including a need for safety.
I can think of no large group of people that would say "Let's work together. But maybe let's decide we are not going to to deal with our life threatening problems that can hurt as sometimes completely at random.
When people talk about helping a third world country what are the first thing that are being mentioned? It is usually building schools and hospitals. Because educated and healthy people can take care of themselves. Why would USA decide to not provide free education and free healthcare is completely beyond me.
Would you rather make 300k and pay 4k for the occasional ER visit or make 50k after tax and pay 100 for the occasional ER visit?
I suppose this comment will get buried in downvotes, but do not ever forget that American engineers are the best paid workers in the entire world.
The trend you're describing is true, but this is an extremely unrealistic average comparison designed only to support a point of view.
So the system works well for me at least, but I know it is much much worse for others
Even the $300k doesn't go as far as you'd think given the costs of housing in the areas that pay that kind of salary.
*https://www.huduser.gov/portal/datasets/il/il21/Medians2021....
That is the biggest issue, thanks to Citizens United Ruling by Republican Supreme Court Appointees, people in the US votes have no power any more. As soon as someone gets elected the do not give a crap about the public. That is when money starts flowing to them in large amounts to push corporate agendas.
Republicans are very good at this game, notice how they are able to block even tiniest efforts are political reform.
This goes too far. Believing it is impossible for politicians to do the right thing is a counsel of despair that harms those who are trying to do the right thing and gives advantage to those that aren't. If you believe it is impossible for democratic action to provide good governance, what is your alternative?
House of Representatives is suppose to be 1 Rep per a fixed number of people. But Congress put a hard limit of 435, that means Small States have more people per Rep than Large States.
For example, Wyoming has 1 Rep for 480900 people.
California has 1 rep per 736000 people. To be fair and agree with the original intent of the US Constitution, California should have about 82 Reps instead of 53.
Texas for that matter should really have 52 Reps instead of 36 has it as now. The way it is now it has one rep per 700279 people.
This will even out things a bit and hopefully get come changes through.
> So even though she was deliriously ill, she hit the road in search of cheaper treatment.
USA #1! Freedom!
If I'm 'forced' to go to the nearest hospital because I may die if I don't, then that hospital should be 'forced' to bill me a fair rate. You can't have free market billing but captured service demand. They do the same with utility pricing - the power company can't decide to 10x the cost of a KW (sorry Texas), so the same should be for medical bills (especially emergency care).
We've 'socialized' firefighting, policing and the defense of our country. Why haven't we done the same with health care? I dunno, maybe not enough Americans have visited Europe or Canada and seen the liberating power of free health care.
From what I can see there is a cost breakdown in the article, but a deeper breakdown would help make sense of these things.
If the hospital has to pay for administrative staff, nurses, doctors, maintenance, electricity, etc. and then deliver a profit to the owner. Is this profiteering or just costs that are passed on to the patient? If it's the latter, then why are those costs high, and so on until something looks disproportionately expensive.
Is it that hospitals are pricing treatment because of having to comply with some expensive regulatory requirement? Or is it that doctors are paid an incredibly high wage compared to doctors in other parts of the world? Or is it that insurance paperwork requires a large administrative staff?
I suspect there is no single answer to these questions, and that there is some complex set of reasons why costs are high.
If it's just profiteering, then the solution is to get stitches from elsewhere. A vet or a nurse or EMT can probably do it freelance too.
With the socialized Medicare/Medicaid already in place, hospitals charge as much as they can knowing the government has deep pockets, will pay, and will give minimal resistance.
Those high prices are then charged to insurance companies as well through closed door, complex negotiations on a case by case basis - super inefficient and expensive.
Also without consumers in the loop even caring what their insurance company is paying, and no price transparency in general, there is no pressure to decrease prices, improve quality or compete in general which are the cornerstones of free market economics.
Luckily price transparency laws were passed last year and are still working their way through the system so hopefully people will start to get a taste of what’s possible soon and decide to take those laws even further.
My sister is an orderly at a nursing home in Texas, and was attacked by a patient, she was was scraped up and had to get stitches, but they wouldn't allow her to fill out a work place injury form or reimburse her for medical expenses, and instead the onsite RN stitched her up at the request of management. The company (pretty large nursing home management company) does not carry workers compensation insurance and instead uses 3rd party arbitration to handle injury "disputes"... so if you are TRULY injured, you have no real recourse than to wait days and days without treatment waiting for this third party to say they will reimburse you.
It teaches the system and how to fight back by a Propublica investigative journalist who had to fight the system himself.
https://www.worldcat.org/title/never-pay-the-first-bill-and-...
Unrelated but I was also audited a similar amount due to clerical error by robinhood + irs. Unnecessarily complicated laws designed to screw 99% of us are working.
And therein lies the problem.. It's been said over and over but there is still no getting around the fact that most people in the US literally can't afford to get sick or have an accident.
Edit: Another question I want to ask after reading some of the other comments. 3. Doesn't big companies in the US keep medical staff for basic medical emergencies like this? That would be free of cost for the employees if things are similar to how it is here.
For a lot of these abuses, shit needs to hit the fan in some way like what happened in Egypt during the Arab risings. Otherwise it's a gradual decades process to move away from the status quo.
Although I enrolled in the universal healthcare scheme (which allowed me to pay up to $1 for treatment), my sinusitis is more serious such that I don't think UHS will properly cure me, causing me to pursue special clinic at public hospitals (where more experienced physicians are available).
I had triple-bypass in 2005. Cost to me? Zilch! If I lived in the US, I'd be dead for the last 16 years.
The American healthcare system seems completely nuts from here.
My monthly contribution is 350 Euro, my employer has to pay 350 Euro per month, too. Hence, I am paying approx. 7500 Euro for my insurance per year. Assuming I work 35 years plus some inflation, then I will pay over 300.000 Euro for my insurance. This excludes contribution before 25 (where my parents paid for me) and my contribution after I retire.
What I want to say: public insurance is NOT free, but also comes with high cost.
But dont worry, there are insurances for that, too. The good ones cost you another 300-400 Euro per year. This makes another 30.000-50.000 Euro on top of what I already pay.
Firstly, insurance shields the patient from the direct cost of healthcare. Second, many people are shielded from the cost of their insurance as it is chosen and paid for by their employer.
£715 (approximately $950) for 4 doses, almost a month's worth with 1 dose per week coming out around $1k/month.
Even ignoring the fact that patients here don't pay, just having NICE and a system which will fight drug companies over costs appears to massively bring down the costs of these medications.
What it boils down to though is simple - corporate greed and regulatory capture.
> "160 million people like their private insurance," Biden said during the November Democratic presidential primary debate.
Democrats are hellbent on keeping the insurance system through any cost saving measure. Republicans haven't actually proposed any plans.
1. https://www.politifact.com/factchecks/2019/nov/21/joe-biden/...
One cause is political. One place I worked govt would only pay a % of the billable rate - this was so politically they could say program was saving money.
So the ‘rack’ rate went through the roof. The irony? We’d have preferred to charge less to cash payors (this was a nonprofit) because they were much less painful to deal with if they paid when service delivered - but instead it was so costly no one could afford cash payments
When I'm headed to the ER, I'm looking for immediate medical attention. I don't want to be shopping around for hidden hospital price estimates, verifying network coverage and deciding if I should Uber, ambulance or drive while I'm half dead. After all that we still got slapped with a $30k bill for half an hour. Cleared the HDHP deductible real fast. Thanks WEC Hospital for the wonderful hours long wait to pay you jacked up prices.
When we had our first kid, we had to repeatedly call the hospital and insurance to make sure it's within network and that the midwives were going to be covered. Then we got slapped with a $15k bill because one of the nurses is outsourced and not within network. After 5 separate hour long conversations on the phone with Aetna we finally managed to get the clinic to lower the bill to $3000 which Aetna then covered. And then 10 days later I received a $15k bill payment reminder.
I think the whole healthcare discussion in the US seems way too distracted with figuring out how to refactor a code base written by clowns, instead of just building a new system ground up. With 50 different states to pander to, I guess that's the logical result.
Pretty glad I left the US, my mind is now cleared of lots of unnecessary baggage.
There's a reason they've popped up like weeds.
And yeah, stiches are definitely free.
You cannot afford to be overweight or t2 diabetic in America, not anymore. The biggest money makers are cardiovascular surgery. These are bankruptcy makers.
Get your teeth checked out and clean. Get physicals - keep your cholesterol low. Get the vaccines and booster. Try to get as healthy a weight as possible. Watch your higher risk behaviors. Avoid cigarettes and alcohol.
Even then its a roll of the dice.
I had a high deductible plan and got snagged with a similar charge but not as large. Same deal, a walk-in by a family member to an emergency room cost over $2, 000, no treatment, simple 15 minute consult. They classified it as a level 4. I understand this is intended to offset overhead and also to discourage unnecessary walk-ins but really ? I argued with the hospital on the level 4 classification and the fact they never informed my family member how much it would cost them prior to (or even after) treatment. They would not budge and I held out until they threatened to send to collection at which point I gave in because it was easier to pay.Also I figured I saved as much on my high deductible plan and it was a lesson learned both to me and my family.
The article is not being up front with the cost calculation.
First, the family in the article likely saved thousands of dollars from their high deductible plan ( for example at the time I was saving at least $300 a month on my plan v lower deductible plan, a savings of $3600 a year in premium). I didn't see anywhere in the article where the premium savings was calculated and it certainly was not deducted from the headline number.
Second, included in the headline number is the unnegotiated undiscounted retail cost. No insured person pays that number. Buried in the article they note the true discounted cost, the "you pay" number which was negotiated by the insurance company as part of their deal with the hospital and passed on to the insured. Granted the discounted price is still outrageous, but it's much lower than the headline.
Third I believe the article fails to mention those with high deductible plans are able to put away the thousands they save on premiums (and more if they choose) in a health savings plan (similar tax advantages to a 529 for education or a 401k roth and similar investment choices of mutual funds, stocks, bonds, cash, etc. ) which is only available for those with high deductible plans and which can grow over a lifetime (this NOT forfeited each year like the medical savings accounts most people are familiar with).
In addition, most areas, and I would bet even in this rural area, there are private stand alone clinics that would have treated him for around $200 . The mistake is to walk in to a hospital emergency room for non-life or death situations, a problem that most people who are on low deductible plans do all the time, driving up artificial demand and real costs for everyone. Hospital emergency rooms are equipped with the most expensive personnel and equipment, they should not be used for non-life threatening problems.
One of the main problems with the American system ( other than government intervention which has royally misallocated resources, screwed with normal market driven supply and demand, and micromanaged health care production, supply, and delivery) is that no one knows how much it will cost given the complexity of the insurance.
Hospital emergency rooms need a simple menu-like sign at the door giving the out-of-pocket cost for common treatments and encouraging people to call their insurance company first and/or go to other clinics for non life threatening issues. The price transparency law that was passed a few years ago did little as it resulted in long lists of obscurely named procedures, usually in a pdf buried in the website.
And/or they should give a reasonable estimate to high deductibles and charge them a r$1000 or so in order to walk through the door, refunding any difference when they walk out.
In addition the low co-pay plans for emergency visits are obscuring the true cost to the hospital, encouraging unnecessary emergency room visits, and pushing these costs onto cash only and high deductible plans. High deductible plans should be encouraged legislatively, rather than demonized.
Also, instead of fighting the tendency of people to run to hospital emergency rooms, hospitals should run lower overhead, lower cost 24 hour clinics adjacent to the emergency rooms and informing people of cost/benefits of each.
While I appreciate this article pointing out the problem of emergency room costs, high deductible plans, are not the problem but one of the solutions to high medical costs. They can regularize supply and demand and increase price transparency.